| 摘要: |
| 目的 探讨镍钛合金肋骨环抱器治疗连枷胸的临床效果及其对血流动力学的影响。方法 选取哈尔滨医科大学附属第一医院2010年9月至2015年10月收治的68例连枷胸患者作为研究对象，按照治疗方式和基本资料匹配原则将其分为对照组和观察组，每组34例。对照组患者接受胸带外固定保守治疗，观察组接受镍钛合金肋骨环抱器手术治疗，随访至2016年10月。比较两组患者的平均住院时间、机械通气时间、引流管留置时间、重症监护室（ICU）观察时间、治疗后疼痛评分、止痛药剂量、血流动力学指标、术后1个月复诊时的肺功能、并发症发生情况和死亡率。结果 观察组患者的平均住院时间、机械通气时间、引流管留置时间以及ICU观察时间均短于对照组（P均<0.05），疼痛视觉模拟量表（VAS）评分和止痛药使用剂量均低于对照组（P均<0.05）。两组患者治疗后24、48 h的心指数（CI）、中心静脉压（CVP）及血管外肺水指数（ELWI）等各项血流动力学指标均高于治疗前（P均<0.05），且观察组患者治疗后24、48 h的CI、ELWI低于对照组，CVP高于对照组（P均<0.05）。观察组患者术后1个月复诊时肺活量（VC）和第1秒用力呼气量与用力肺活量的比值（FEV1/FVC）均高于对照组（P均<0.05），但两组患者最大呼气中段流量（MMEF）和最大呼气峰流速（PEF）差异均无统计学意义（P均>0.05）。观察组患者并发症总发生率低于对照组[47.1%（16/34）vs 17.6%（6/34），P<0.05]，死亡率（2.9%，1/34）低于对照组（17.6%，6/34；P<0.05）。结论 镍钛合金肋骨环抱器治疗连枷胸具有创伤较小、术后恢复较快、并发症发病率低、有效改善患者疼痛及血流动力学指标等优点，是一种安全有效的治疗手段。 |
| 关键词: 镍钛合金肋骨环抱器 胸带外固定 连枷胸 血流动力学 |
| DOI：10.16781/j.0258-879x.2017.11.1477 |
| 投稿时间：2017-05-29修订日期：2017-08-27 |
| 基金项目: |
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| Clinical efficacy of nickel titanium alloy embracing fixator in treatment of patients with flail chest and its effect on hemodynamics |
| QU Jun-feng,CHANG Hao* |
(Department of Thoracic Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the clinical efficacy of nickel titanium alloy embracing fixator in the treatment of flail chest and its effect on hemodynamics. Methods A total of 68 patients with flail chest who were admitted to the First Affiliated Hospital of Harbin Medical University from Sep. 2010 to Oct. 2015 were enrolled in this study. The patients were divided into control group and observation group according to different treatment methods, with 34 cases in each group. Patients in the control group received conservative treatment of thoracic band external fixation, and those in the observation group received operative treatment with nickel titanium alloy embracing fixator; both groups were followed up until Oct. 2016. The hospital stay, duration of mechanical ventilation, drainage tube indwelling time, intensive care unit (ICU) observation time, post-treatment pain, dosage of analgesics, hemodynamics, pulmonary function 1 month after surgery, complications and mortality of patients were compared between the two groups. Results Compared with the control group, the average hospital stay, duration of mechanical ventilation, drainage tube indwelling time and ICU observation time of patients were significantly shorter in the observation group (all P<0.05), and the Visual Analogue Scale score and dosage of analgesics were significantly lower (both P<0.05). The hemodynamic indexes such as cardiac index (CI), central venous pressure (CVP) and extravascular lung water index (ELWI) at 24 h and 48 h after treatment were significantly higher than those before treatment in both groups (all P<0.05). The CI and ELWI in the observation group were significantly lower than those in the control group at 24 h and 48 h after treatment (both P<0.05), while the CVP in the observation group was significantly higher (P<0.05). The vital capacity (VC) and the ratio of forced vital capacity (FVC) in one second to FVC (FEV1/FVC) in the observation group were significantly higher than those in the control group (both P<0.05), while there were no significant differences in maximal mid-expiratory flow and peak expiratory flow rate between the two groups (both P>0.05). The overall incidence of complications in the observation group was significantly lower than that in the control group (47.1%[16/34] vs 17.6%[6/34], P<0.05), and the mortality was significantly lower than that in the control group (2.9%[1/34] vs 17.6%[6/34], P<0.05). Conclusion Nickel titanium alloy embracing fixator is a safe and effective method in the treatment of flail chest with less trauma, quick recovery, low incidence of complications, and can improve hemodynamics and reduce pain of patients. |
| Key words: nickel titanium alloy embracing fixator thoracic band external fixation flail chest hemodynamics |
